Patient Safety in Anesthesia: Guidelines and Practices

Introduction

Anesthesia is a critical component of modern medicine, allowing patients to undergo surgeries and medical procedures with minimal discomfort or pain. While it plays a pivotal role in healthcare, the administration of anesthesia carries inherent risks. To mitigate these risks and ensure patient safety, healthcare providers adhere to stringent guidelines and best practices.

What Is the Role of Anesthesia in Healthcare?

Anesthesia is a medical specialty that involves the use of drugs or other interventions to induce a reversible loss of sensation, typically for the purpose of performing surgical procedures. It encompasses a broad spectrum of techniques, ranging from local anesthesia, which numbs a specific area of the body, to general anesthesia, which renders the patient unconscious and unresponsive to pain.

The administration of anesthesia is a complex process that requires a multidisciplinary team, including anesthesiologists, nurse anesthetists, and anesthesiology assistants, to work together to ensure patient safety. While anesthesia enables surgeons to perform complex and often life-saving procedures, it also carries risks that must be carefully managed.

What Are the General Guidelines for the Safe Practice of Anesthesia?

Below are the general guidelines adopted by the World Federation of Societies of Anesthesiologists on June 13, 1992, for patient safety:

General Standards:

1. Professional Status: Providing anesthesia is important in healthcare and should get enough support and resources. It is best when the people giving anesthesia are well-trained and are certified medical experts who can make decisions on their own. If someone else is giving anesthesia, they should also be well-trained and certified, and they should be guided and supervised by a doctor who specializes in anesthesia.

2. Professional Organizations: Anesthesia doctors should create groups in their local areas, regions, and nationally to set rules for how they work, make sure the training is good, and give certificates to show they are qualified. These groups should also connect with similar groups in their area or country and around the world.

3. Training, Certification, and Accreditation: People who want to become anesthesia doctors should have enough time and places to learn properly, both at the beginning and throughout their careers. They should also get certificates to show they are trained and allowed to work.

4. Records and Statistics: Every time anesthesia is given, a record of what happened should be written down and kept with the patient's medical records. This should include what the patient was like before the surgery and how they did after. People, groups, and regions should gather information to make anesthesia safer, better, and more efficient.

5. Peer Review: Hospitals and regions should have ways to check how anesthesia is done regularly. Anesthesia doctors should talk privately with their colleagues about cases and issues. They should also have ways to fix any problems in how they work. Reporting problems without saying who one is can help make things better and safer. Making sure no one shares one’s private information is important.

6. Workload: There should be enough trained anesthesia doctors so that each patient gets good care. Anesthesia doctors need time to learn more, do administrative work, do research, and teach others.

7. Personnel: Each patient getting anesthesia should have a dedicated anesthesia doctor who stays with them throughout the whole process, from getting ready for the surgery to waking up after it. The anesthesia doctor is responsible for taking the patient to the recovery area and making sure the patient is okay. They should also be available for help until the patient is fully recovered. If they need to share responsibilities with someone else, that person should also be qualified and know all about the patient and the anesthesia.

Peri-Anesthetic Care and Monitoring: The most important part of looking after a patient during anesthesia is to have an anesthesia specialist (the person in charge of anesthesia) present and pay close attention to the patient and the anesthesia equipment the whole time during the surgery.

Pre-Anesthetic Care: Before giving anesthesia, the patient should be checked by the anesthesia specialist. The anesthesia specialist needs to make sure that all the equipment they will use during anesthesia is working properly. It is also a good idea to have clear guidelines (protocols) to help with this equipment check. The anesthesia specialist should also make sure there is someone else available to help if needed. This helper should know what to do and be trained for the tasks required during the procedure.

Monitoring During Anesthesia:

1. Oxygenation:

• Oxygen Supply: It is a good idea to give extra oxygen to all patients who are getting general anesthesia. The anesthesia specialist should make sure the oxygen supply is working properly. When they use other gasses like nitrous oxide along with oxygen, they need to check that there is enough oxygen in the air the patient breathes, especially at the start of each anesthesia session. It is also a good idea to keep an eye on the oxygen level throughout the whole anesthesia using a machine that can sound an alarm if the oxygen gets too low. Having an alarm for when the oxygen supply stops working and a device that makes sure the patient does not get air with too little oxygen is also a really good idea. And there should be a system to make sure the right gas sources are connected.

• Oxygen in the Patient: Tissue oxygenation should be monitored whenever possible through visual examination. Adequate illumination and patient exposure should be ensured whenever feasible unless an appropriate monitor is in use. The continuous use of a quantitative oxygenation monitor, such as a pulse oximeter, is highly recommended.

2. Airway and Ventilation

• Airway and ventilation quality should be checked all the time by watching and listening whenever possible.

• If a breathing circuit is used, keep an eye on the movement of the bag that holds the air. It is strongly advised to keep listening continuously with a stethoscope placed on the chest, neck, or near the esophagus.

• It is highly recommended to make sure that the tube going into the windpipe is in the right place and that the air going in and out is measured and shown as a waveform and concentration of carbon dioxide.

• When a machine is used to help with breathing, there should be an alarm that goes off if something gets disconnected while the machine is running.

• It is a good idea to keep track of how much gas is breathed in and out all the time.

3. Circulation

• Cardiac Rate and Rhythm: Keep an eye on the circulation all the time. Touching or checking the pulse and listening to the heart sounds should be ongoing. It is strongly recommended to continuously monitor and show the heart rate using a machine like a plethysmograph (either on its own or as part of a pulse oximeter) or an electrocardiograph. Having a defibrillator available is also highly recommended.

• Tissue Perfusion: Make sure the body tissues are getting enough blood by checking them regularly during the procedure. Using a machine like a plethysmograph or a capnograph to keep track continuously is highly recommended.

• Blood Pressure: Measure the blood pressure in an artery at certain times (usually at least every five minutes, and more often if needed based on the patient's condition). In some cases, it is a good idea to keep a constant record of the arterial pressure.

• Temperature: A way to check the patient's temperature should be available and used regularly when needed, especially in long or complicated anesthesia cases and with young children. It is highly advised to keep measuring the temperature continuously in patients where changes in temperature are expected, intended, or suspected. Using electronic devices for this purpose is recommended.

• Depth of Anesthesia: Check how deep the anesthesia is regularly by clinical methods. It is a good idea to keep measuring the concentration of nitrous oxide and volatile agents in the air breathed in and out continuously.

• Neuromuscular Function: If drugs that affect muscle function are used, it is recommended to use a device that stimulates the peripheral nerves to check the patient's muscle function.

Post-Anesthesia Care:

1. Facilities and Personnel: Anyone who has had anesthesia that affects how the central nervous system works or has lost their protective reflexes should stay where they were anesthetized or be moved to a place meant for post-anesthesia recovery.

2. Monitoring: Everyone should be carefully watched and monitored based on how their nervous system is working, their vital signs, and their overall health, with a focus on making sure they are getting enough oxygen, their breathing is okay, and their circulation is good. Using a pulse oximeter is highly recommended.

Conclusion

In summary, ensuring patient safety during anesthesia and in the post-anesthesia period involves continuous monitoring, adherence to established guidelines, and the use of advanced technology. Anesthesia specialists play a critical role in safeguarding patients by maintaining vigilance, assessing vital signs, and employing monitoring devices. These practices, along with well-equipped facilities, contribute to a safer and more effective anesthesia experience, ultimately promoting better patient outcomes.